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Tavis Smiley

News/Business. (2012) Peter Ubel, Duke University. New. (CC) (Stereo)

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Us 4, Dr. Peter Ubel 4, California 2, Pbs 2, U.s. 2, Tavis Smiley 2, Smiley 1, Adam 1, Ethicisit 1, Mr. Romney 1, D.l. Hughley 1, Los Angeles 1,
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  WHUT    Tavis Smiley    News/Business.  (2012) Peter Ubel,  
   Duke University. New. (CC) (Stereo)  

    October 18, 2012
    7:00 - 7:30pm EDT  

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tavis: good evening. from los angeles, i am tavis smiley. tonight, we continue our road to health series with one of the most overlooked aspects of health care, the doctor-patient relationship. dr. peter ubel is a scientist at duke university, who looks at how decisions are made and why. communications may hold the key for health care. his new book is called "critical decisions." we are glad you could join us with dr. peter ubel. right now. >> there is a saying that dr. king had that said there is always the right time to do the right thing. i just try to live my life every day by doing the right thing. we know that we are only halfway to completely eliminate hunger, and we have work to do. walmart committed $2 billion to fighting hunger in the u.s. as we work together, we can stamp hunger out.
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>> the california endowment. health happens in neighborhoods. learn more. >> and by contributions to your pbs station from viewers like you. thank you. tavis: dr. peter ubel is a widely respected scientist and physicians at duke university. his latest text is called "critical decisions." doctor, good to have you on this
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program. >> good to be here. tavis: i should have put a darker blue tie on. my apologies to you and all of the good folks at duke. it seems to me that so often when doctors and patients get together, what they are talking about, doctor, are life and death decisions. tell me how honesty, how transparency, how open this enters the room in a setting like that -- how open this -- openness enters the room in a setting like that. how do we get to where that is central in a conversation? >> i actually think that most of
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the time, it is pretty honest and transparent, but often in a foreign language, where the physician is doing their best to explain what is going on to be patient, but they are using jargon that they had to go to medical school to understand. whether they talk too fast or too slow -- that is pretty much the norm. tavis: there was a point in this country years ago, as you know, where at least we were told that we were making a paradigm shift in the health profession, where patients had more say, a patient's right to x, y, and z, and as i read the book, it seems like we have failed in that. >> we empowered patients, but we did not tell them what it meant
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if they were alone to make the decision, so we started the revolution, but we have not completed it. tavis: your book is full of anecdotes and personal stories. it is always difficult. i think it is necessary and valuable to empower people with information that can help them live better lives. i say all of the time that if -- your't got yhour health, you ain't got anything. let's go inside the text of "critical decisions." sell everyday people can increase it and understand it. -- so everyday people can embrace it and understand it.
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>> we did not have written language for a long time, but there are a lot of stories in the book. over all, -- overall, i try to say. i start the story with 1975, when a woman was told that she had a lump in her breast and that she needed to have it removed, and she went to get the biopsy, and she woke up at the end of the surgery, not only was the biopsy done, but her breast was removed, the surrounding tissue, what was called a radical mastectomy, even though the position that there was a new study coming out -- even though the physician knew that there was a new study coming out questioning that. that was a president's wife.
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just 20 years later, i got an emergency call. i am not a surgeon. i was in on call ethicisit, and a woman had cancer -- i was an on-call ethicisit. she had a throat cancer, and they had planned to remove the tumor. when they got in there, there was more tumor than they thought there would be, and he knew that removing the tumor would remove her ability to speak, so he said, "what should i do?" what do you think? i am asking you. so she is asleep on the operating room, in he can go in and take out the rest of the tumor -- and he can go in and take out the rest of the tumor. he could let her wake up, and they would talk about it, and if they went to do it a few weeks
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later, -- i said, "you need to wake her up." tavis: i said communicate. all right. do you think that that is the norm, or is that the exception to the rule >> doctors are more aware that some decisions are not just medical decisions. they are of value decisions. but it is not the norm. we are struggling, trying to figure out how to work together, and that is what i am trying to help us do better. tavis: there is this old adage
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in business that the customer is always right. i get what we mean when we say that, but that is not always true. the customer is not always right, and you get it. so i ask you, is the patient always right? it is my body. if it is what i what, am i always right? >> no. my job as a physician is to understand if what you're telling me reflects some deep valleys. that is great. i need to know that, but there may be some misinformation. maybe you decided you do not want to have that procedure done because you hate surgery, and, "i will never feel good because you have to remove part of my leg," but there are some the -- some that do great. tavis: what about this quagmire?
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it has to do with some positions, not all, who are pushing procedures for a variety of reasons, because they are using this particular equipment or medicine or whatever happens, but i can think of a couple of times in my life where even my own doctors, i have gone to get second opinions. at one point, i was going in for a particular surgery, and i thought, you know what? i am going to pass on that. the date was set, and things were ready to rock-and-roll, and i am glad i did. it took some time to heal. but i did not want to get my foot caught on and that. -- my foot cut on and all of that. what about this idea of doctors being pushed to do x, y, and z.
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>> i believe doctors believe in what they do. if you have a slow-growing prostate cancer, you might get surgery to treat that, or you might get radiation. if you go to a surgeon, they will probably recommend that you get surgery. if you go to another, you might get that. they spend their day curing people with these treatments, and the cannot imagine any other treatment. tavis: i do not recall you talking specifically about this, but as a person of color, it is important to me, and that is the breakdown i have seen so many times over a lack of cultural confidence, it just not trained on how to communicate, navigate the relationship with patients from different communities, different norms, different
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values, different understandings. it is a real issue. >> it is. and i think the more you can relate to your position, the better off you are going to be. there are age differences. i am 50 years of them. i started medicine at 27 years old. i looked really, really young. i was taking care of a man in his fifties, and he said, "people of our age." and i thought, i am only 27, but that was one of the biggest compliments of my career. tavis: so rate for me, if you will, on a scale of 1 to 10 how we are doing? -- how we are doing. >> i think we went from 0 to 6 or 7, and we were inching along
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a little bit. communicating better. there are things called the decision aids that got us up to 6 or so. tavis: what is holding us back? why are we stuck? >> part of why i tell a lot of stories in the book is to let people visualize what might happen to them. "i remember that. you can get confused, and the doctor does not realize that." it is getting people ready for when they have those critical decisions to make. i put in some more information that is not as relevant to some readers. tavis: i just ask a question, for example, about cultural competence.
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retrainren't to positions, what are two or three ways -- if we were to we trained physicians, what are two or three ways -- if we were to retrain physicians? >> including critiquing them. stepping back and watching yourself interact. there is research showing doctors dramatically improve their behavior if they can see or hear themselves. tavis: how much of this is about patients becoming their own best advocates? >> the right choice is not a medical thing. ultimately, it might be a trade- off between length of life and quality of life. it is like a waiter giving you a recommendation. we have to know what you care about to give you a good
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recommendation. tavis: what advice in regards to patients becoming their best advocates, and we have to prepare patients to be prepared, so talk to me about how a patient feels empowered to walk into his or her doctor's office and have the kind of conversation that needs to be had -- >> maybe your spouse is not so shy. maybe he or she will jump in there for you. maybe it is your kid. that is one thing. bring someone in. another one is to arm yourself with information before you get to the counter so that you are just up to speed as much as you can be with your situation.
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tavis: where do you find that patients are most lacking when it comes to information about their own health? >> that is a good question. it varies so much. some people come in, and they are practically encyclopedic, but they are not in touch with their own emotions. medical decisions often carry a lot of emotions. they are afraid of needles. "can you try the neva once or twice and see if it bothers you -- can you try the needle once or twice and see if it bothers you?" tavis: how much this has to deal with patients being emotional, and i want to ask you that, because if ever there is something to be emotional about, it is about your health. but from the physicians side of
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the coin, how frustrating is it offrom the physicians' side the coin how frustrating is it? >> i think there are times when you have to realize you have to let the emotions come down and then come back another day and try again. sometimes, we physicians have been there and done that that we forget what it is like for a patient. we say, "you have a very small, localized cancer. do not worry. it is no big deal." but to the patient, they hear "cancer," and nothing after that. do not just assume that he knows what you are thinking and feeling. tavis: this is, again, something not covered in your text, but it
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is personal, a personal ax to grind, and i grind this ax due to personal interest, but also because i am a personality. i am ushered in the back door, and they get to me rather quickly. that is not all of the time. that is not always the case. i have in my life been sent to see a specialist, and i get to the specialist, and they do not know me from adam. it is not my personal physician, and i have found myself sitting in waiting rooms and the rat race. it is not something covered directly in your text, but i wonder how much of this relationship is with patients being made to feel like they are just another number, they are -- if i get to your office on time,
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do not make me sit for 1.5 hours to two hours, or rush me when i get in there. i am trying to figure out, any other relationship, you want to feel like you are respected, and you want to feel like you matter. there are people who are watching right now who know exactly. they understand this. how much of that impact is this? -- impacts this? you guys are the worst. and then you get overcharged. again, i am grinding mine ax. -- my ax. it is horrible. >> i really work hard to stick to my schedule. there are days where i was late. and that was because someone had a really big problem, and i had
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to work with the emergency room, and the first and i would do is to apologize profusely. -- the first thing i would do is to apologize profusely. not everybody does that. if you do not get a good response from your doctor, maybe it is time to find another one. tavis: you mentioned that at one point, you worked with the v.a. system. how do we do as a nation dealing with those who served? there are some thoughts about how we treat these soldiers when they are coming home. tell me how you think we are doing in the v.a. system.
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>> as you read in the news, there are certain that have -- there are some that have problems. now we are ramping of the mental health services, and we are not doing it fast enough. but we are ramping up -- we are ramping up mental health services, and we are not doing it fast enough. it often does as well or better than other places people are getting their care. we sometimes have things years before others. to make sure when i order a medication, if it conflicts with another medicine you are on, i get a warning. i think on average, outstanding care. tavis: since you raised it, what about digital records, and the concerns some patients might
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have? >> you are not talking like this as a doctor, you are talking like this, so i think a good physician, they take that computer monitor, and they turn it over, and they say, "look at how your blood pressure is going up," and it is a learning model. i think it can be a real way to improve communication. tavis: our population, as you well know as a physician, is aging. what is the relationship between the two? >> older people, they just defer to their doctors, and younger people -- that is partly true. it is amazing when you get a sudden illness. all of a sudden, you are so scared.
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i had a bulging disk in my back. -- disc in my back. when i had my own back problem, i did not go to the library once. it is amazing. when it is your body on the line. tavis: this debate we have had recently about health care. and if mr. romney were to win, they want to do what they can to overturn obamacare and whatever that means. the supreme court has weighed in on some aspects of this. the issues raised in the text? >> a complicated topic. no matter who is elected in november and who is president in january, people are going to
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have what they call more skin in the game. we are paying more than enough pockets for health care than we ever have had. -- we are paying more than ever out of pocket for health care. "it is really costing me a lot of money, dr.." -- doctor." tavis: there is a reason they call it "the practice of medicine at." sometimes, the right decision is not made, because doctors are not perfect. again, that is why they call it the practice of medicine, so what do you say to patients when the right decision was not made? >> you know, you cannot live your life in reverse, right? you just have to go forward with
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what the next decision is and how to get on with your life. living with regret, i do not see the point of it. if you realize it was a bad decision, you might want to change physicians or at least know what you are upset with what happens. tavis: the book is called "critical decisions," written by dr. peter ubel. good to have you on the program. thank you for your insights. that is our show for tonight. you can download our app. thanks for watching, and as always, keep the faith. captioned by the national captioning institute --www.ncicap.org-- >> for more information on today's show, visit tavis smiley at pbs.org. tavis: hi, i'm tavis smiley. join me next time for a conversation with comedian d.l. hughley.
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that is next time. we will see you then. >> there is a saying that dr. king had that said there is always the right time to do the right thing. i just try to live my life every day by doing the right thing. we know that we are only halfway to completely eliminate hunger, and we have work to do. walmart committed $2 billion to fighting hunger in the u.s. as we work together, we can stamp hunger out. >> the california endowment. health happens in neighborhoods. learn more. >> and by contributions to your pbs station from viewers like you. thank you.
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>> be more. pbs. >> be more. pbs.
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